Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| The Woodlands, TX | $58.86 | $0.00 – $213.53 | 279,301 | 168 |
| Monroeville, PA | $19.11 | $0.69 – $395.23 | 280,109 | 162 |
| Cleveland, MS | $54.44 | $0.00 – $188.84 | 280,493 | 56 |
| Durant, OK | $131.66 | $14.57 – $719.00 | 280,659 | 86 |
| Manteca, CA | $38.07 | $0.00 – $1,096 | 280,839 | 91 |
| Grove City, OH | $55.65 | $14.53 – $165.28 | 280,908 | 169 |
| Loveland, CO | $92.13 | $0.00 – $263.45 | 281,108 | 221 |
| Oakdale, CA | $20.65 | $0.00 – $35.87 | 281,389 | 21 |
| Pineville, KY | $33.60 | $6.30 – $47.16 | 281,854 | 33 |
| Janesville, WI | $35.07 | $0.00 – $292.58 | 281,866 | 227 |
| Ottumwa, IA | $19.45 | $0.00 – $131.20 | 281,947 | 93 |
| Manhasset, NY | $88.12 | $0.00 – $184.10 | 281,986 | 215 |
| Wilmington, CA | $15.56 | $0.00 – $119.80 | 282,262 | 50 |
| Hewlett, NY | $65.00 | $1.86 – $170.07 | 282,456 | 54 |
| Nicholasville, KY | $37.60 | $1.93 – $206.50 | 282,538 | 81 |
| Alamogordo, NM | $78.99 | $10.03 – $201.61 | 282,786 | 104 |
| Ocean Springs, MS | $56.20 | $0.00 – $160.29 | 283,689 | 148 |
| Winchester, TN | $37.28 | $2.83 – $75.38 | 283,740 | 73 |
| Mccomb, MS | $44.61 | $0.02 – $132.66 | 283,758 | 104 |
| Norwalk, OH | $46.78 | $0.00 – $88.72 | 284,475 | 80 |
| Medway, MA | $35.31 | $14.52 – $98.18 | 284,665 | 23 |
| West Springfield, MA | $63.17 | $0.00 – $106.69 | 284,965 | 77 |
| Fairfield, OH | $56.34 | $1.38 – $318.75 | 285,404 | 165 |
| Logan, WV | $39.94 | $0.00 – $84.95 | 285,756 | 78 |
| Grand Forks, ND | $95.18 | $0.00 – $509.10 | 286,343 | 268 |
| Lemoore, CA | $3.45 | $0.00 – $23.51 | 286,666 | 20 |
| Findlay, OH | $46.58 | $0.00 – $127.61 | 287,018 | 191 |
| West Hollywood, CA | $22.51 | $0.00 – $331.50 | 287,022 | 213 |
| Massillon, OH | $50.76 | $2.58 – $132.48 | 287,097 | 111 |
| Elk Grove, CA | $36.01 | $0.00 – $1,139 | 287,299 | 183 |
| Tullahoma, TN | $39.28 | $0.00 – $115.45 | 287,342 | 96 |
| Fishersville, VA | $57.81 | $0.95 – $136.58 | 287,488 | 180 |
| Bellevue, WA | $47.14 | $0.00 – $845.64 | 287,634 | 393 |
| Davis, CA | $14.39 | $0.00 – $502.60 | 288,011 | 165 |
| Waianae, HI | $216.70 | $0.00 – $360.12 | 288,068 | 98 |
| Bismarck, ND | $90.15 | $3.01 – $476.36 | 288,303 | 318 |
| Kew Gardens, NY | $67.65 | $11.91 – $128.53 | 288,326 | 37 |
| Chambersburg, PA | $21.92 | $0.00 – $272.80 | 289,091 | 229 |
| Easley, SC | $50.73 | $0.55 – $140.16 | 289,364 | 108 |
| East Liverpool, OH | $53.33 | $0.00 – $123.75 | 289,908 | 64 |
| Cayey, PR | $24.55 | $0.00 – $159.39 | 290,420 | 110 |
| Harrisonburg, VA | $55.84 | $0.00 – $96.77 | 290,915 | 189 |
| Winter Park, FL | $76.40 | $0.00 – $318.75 | 291,093 | 169 |
| Killeen, TX | $42.66 | $0.00 – $122.76 | 291,117 | 159 |
| Westminster, MD | $78.02 | $0.00 – $181.53 | 291,380 | 173 |
| Layton, UT | $54.85 | $0.00 – $177.14 | 291,501 | 164 |
| Miamisburg, OH | $50.60 | $2.48 – $318.75 | 292,092 | 152 |
| Park Ridge, IL | $54.11 | $7.01 – $165.48 | 292,526 | 326 |
| Chino Hills, CA | $14.70 | $0.00 – $130.90 | 293,723 | 64 |
| Gary, IN | $51.27 | $3.25 – $88.75 | 293,741 | 65 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.